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21.3 Limited Benefit Medicaid .................................................................................................................. 290 21.4 Covered Services ............................................................................................................................... 291 21.4.1 Covered Services Introduction ................................................................................................... 291 21.4.1.1 Medicaid Card Services ....................................................................................................... 292 21.4.2 Transportation ........................................................................................................................... 292 21.4.2.1 Ambulance .......................................................................................................................... 292 21.4.2.2 Specialized Medical Vehicle ................................................................................................ 293 21.4.2.3 Common Carrier .................................................................................................................. 293 21.4.2.4 Transportation Coordination .............................................................................................. 293 21.5 Copayment ........................................................................................................................................ 293 21.5.1 Introduction ............................................................................................................................... 293 21.5.2 Copay Exempt Populations ........................................................................................................ 293 21.5.3 Copay Exempt Programs ............................................................................................................ 294 21.5.4 Copay Exempt Services .............................................................................................................. 294 21.6 HMO Enrollment ............................................................................................................................... 294 21.6.1 SSI HMO Enrollment .................................................................................................................. 295 21.6.1.1 Voluntary HMO Enrollment ................................................................................................ 295 21.6.2 HMO Selection and Assignment ................................................................................................ 296 21.6.3 Open Enrollment and Lock-in Periods ....................................................................................... 297 21.6.4 HMO Disenrollment ................................................................................................................... 297 21.6.4.1 Automatic Disenrollment .................................................................................................... 297 21.6.4.2 Voluntary Disenrollment ..................................................................................................... 298 21.6.4.3 Involuntary Disenrollment .................................................................................................. 298 21.6.5 Enrollment Exceptions ............................................................................................................... 299 21.7 ForwardHealth Cards ........................................................................................................................ 301 21.7.1 ForwardHealth Cards Introduction ............................................................................................ 301 21.7.2 Homeless .................................................................................................................................... 302 21.7.3 Pharmacy Services Lock-in Program .......................................................................................... 302 21.7.4 Temporary Cards ........................................................................................................................ 302 21.7.5 Lost or Stolen Cards ................................................................................................................... 302 21.8 Waiver of Medicaid Benefit Limitations ........................................................................................... 303 21.9 Third Party Coverage ......................................................................................................................... 303 21.10 Reserved ......................................................................................................................................... 303 21.11 Five Percent Cost Share Limit ......................................................................................................... 303 21.11.1 Copay Limits for Members and Programs exempt from copays ............................................. 304